School of Health and Society, University of Salford, Frederick Road Campus, Salford, UK.
School of Health Sciences, University of Brighton, Darley Road Campus, Eastbourne, UK.
Gait Posture. 2022 Feb;92:351-358. doi: 10.1016/j.gaitpost.2021.12.003. Epub 2021 Dec 6.
Onset of walking in infants leads to regular cyclic loading of the plantar foot surface for the first time. This is a critical period for evolving motor skills and foot structure and function. Plantar pressure literature typically studies gait only once walking is established and under conditions that artificially constrain the walking direction and bouts compared to how infants move in the real-world. We therefore do not know how the foot is loaded when self-directed walking is first achieved and whether it changes as walking is practiced. Research question How do pressures on the plantar foot in real-world walking change from new to confident walking? Methods Fifty-seven infants participated in a two-site longitudinal study. Bespoke child-friendly spaces incorporated large pressure platforms and video. Data was collected at two milestones: new (403 days) and confident (481 days) walking. Steps were defined as walking straight or turning medially/laterally. Pressure variables were calculated for eight-foot regions and compared between milestones. Results Confident walking resulted in more steps (median: 18 v 35) and almost twice as many turning steps. During straight-line steps, confident walking increased peak pressures in the medial heel (median: 99.3 v 106.7kPa, p < .05) and lateral forefoot (median: 53.9 v 65.3kPa, p < .001) and reduced medial toe pressure (median: 98.1 v 80.0kPa, p < .05). Relative medial midfoot contact area reduced (median: 12.4 v 11.2%, p < .05) as absolute foot contact increased. A faster transition across stance and a reduced relative contact time in the forefoot were recorded in confident walking. Significance Pressures change rapidly as walking is initiated with significant differences in foot loading evident within an average 77 days. Importantly, these changes differ in straight and turning walking. Continued reliance on assessment of straight-line walking during early stages of ambulation likely fails to characterise 26% of steps experienced by infant feet.
婴儿开始行走时，足底首次受到有规律的周期性负荷。这是发展运动技能和足部结构与功能的关键时期。足底压力文献通常仅在行走建立后研究步态，并且在人为限制行走方向和回合的条件下进行，与婴儿在现实世界中的运动方式相比。因此，我们不知道当自主行走首次实现时，脚部是如何受力的，以及随着行走的练习，它是否会发生变化。
在现实世界中，当婴儿从刚开始学会走路到自信行走时，足底所受的压力会发生怎样的变化？
57 名婴儿参与了一项两地纵向研究。专门为儿童设计的友好空间包含大型压力平台和视频。数据在两个里程碑处收集：新（403 天）和自信（481 天）行走。将步骤定义为直走或向内侧/外侧转弯。在两个里程碑处比较了八个足部区域的压力变量。
自信行走时，步伐更多（中位数：18 步对 35 步），转弯的步伐几乎是两倍。在直线行走时，自信行走增加了内侧足跟（中位数：99.3kPa 对 106.7kPa，p<.05）和外侧前脚掌（中位数：53.9kPa 对 65.3kPa，p<.001）的峰值压力，并降低了内侧脚趾的压力（中位数：98.1kPa 对 80.0kPa，p<.05）。相对中足接触面积减小（中位数：12.4%对 11.2%，p<.05），而绝对足部接触面积增加。在自信行走中，记录到支撑相的过渡更快，前足的相对接触时间减少。
随着行走的开始，压力迅速变化，足部受力有明显差异，在平均 77 天内就可以看出。重要的是，这些变化在直线和转弯行走中是不同的。在早期步态阶段，继续依赖于直线行走的评估可能无法描述婴儿足部经历的 26%的步幅。
